Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
OptumLabs, Visiting Fellow, Cambridge, MA, USA.
Int Rev Psychiatry. 2020 Feb;32(1):31-38. doi: 10.1080/09540261.2019.1656176. Epub 2019 Sep 23.
Sleep disturbances are common sequelae of traumatic brain injury (TBI) that are associated with poorer recovery. This is important among older adults, who fare worse following TBI relative to younger adults and have a higher prevalence of sleep disorders. The objective of this study was to assess the risk of newly-diagnosed sleep disorders following TBI among adults ≥65 years. Using a large commercial insurance database, older adults diagnosed with TBI between 2008-2014 ( = 78,044) and non-TBI controls ( = 76,107) were identified. The first dates of diagnosis of four common sleep disorders (hypersomnia, insomnia, obstructive sleep apnea, and restless legs syndrome) and a composite of any sleep disorder were identified. To compare groups, this study used a difference-in-differences (DID) approach, accounting for pre-index differences between cohorts and the trends in sleep diagnoses over time. Individuals with TBI were more likely to have any newly-diagnosed sleep disorder before (14.1% vs 9.4%, < 0.001) and after (22.7% vs 14.1%, < 0.001) the index date. In fully adjusted DID models, TBI was associated with an increased risk of insomnia (rate ratio (RR) = 1.17; 95% confidence interval (CI) = 1.08-1.26) and any sleep disorder (RR = 1.13; 95% CI = 1.08-1.19). Following TBI among older adults, screening and education on sleep disorders should be considered.
睡眠障碍是创伤性脑损伤 (TBI) 的常见后遗症，与恢复较差有关。这在老年人中尤为重要，他们在 TBI 后比年轻人恢复得更差，并且睡眠障碍的患病率更高。本研究的目的是评估 65 岁以上成年人 TBI 后新发睡眠障碍的风险。使用大型商业保险数据库，确定了 2008-2014 年期间被诊断为 TBI 的老年人（n=78044）和非 TBI 对照者（n=76107）。确定了四种常见睡眠障碍（嗜睡症、失眠症、阻塞性睡眠呼吸暂停和不宁腿综合征）和任何睡眠障碍的首次诊断日期。为了比较两组，本研究使用了差异-差异（DID）方法，考虑了队列之间的指数前差异和随时间推移的睡眠诊断趋势。TBI 患者在指数日期之前（14.1%比 9.4%， < 0.001）和之后（22.7%比 14.1%， < 0.001）更有可能被诊断为任何新发睡眠障碍。在完全调整后的 DID 模型中，TBI 与失眠症（RR=1.17；95%置信区间 [CI]：1.08-1.26）和任何睡眠障碍（RR=1.13；95% CI：1.08-1.19）的风险增加相关。在老年人中发生 TBI 后，应考虑对睡眠障碍进行筛查和教育。
